Diabetes – a modern epidemic

‘Mum, I think there’s something wrong with me.’ These were 15-year-old Steven’s words to his parents when they returned from a three-week overseas trip. In that short time, their strapping son lost five kilos, was excessively thirsty and needed to go to the toilet so often that he felt it might be easier to set up camp in there.

Within days Steven was diagnosed with insulin-dependent Type 1 diabetes, and life as he and his family knew it was gone forever. Each day is now an exercise in maintaining the right level of blood sugar to keep him healthy…and alive.

He must wake, eat, exercise and inject insulin at controlled intervals – spontaneity a memory. Instead, lancets, insulin pens, glycemic index foods and other bewildering terms have become second nature as he and his family learn to live with diabetes – Australia’s sixth major cause of death.

What is Diabetes?

When we eat, the digestive system breaks down carbohydrates into the simple sugar glucose, which is then transported to each cell by the bloodstream. The pancreas secretes the hormone insulin, which allows the glucose to migrate from the blood into the cells.

Once inside a cell, the glucose is 'burned', along with oxygen, to produce energy. The body converts any excess glucose into another form called glycogen.

Glycogen is then stored inside muscle tissue and the liver, ready to supplement blood sugar levels should they drop between meals or during physical activity. Diabetes is a chronic disorder that occurs when the body is unable to use blood sugar (glucose).

There are two major types of diabetes:

• Type 1 - an auto-immune disease, also known as juvenile diabetes and insulin dependent diabetes mellitus (IDDM); and
• Type 2 - a metabolic disorder, also known as adult onset diabetes and non-insulin dependent diabetes mellitus

A third type, gestational diabetes, occurs in around 3% of pregnancies and usually does not continue after the birth of the baby. All women who contract gestational diabetes are at an increased risk of developing Type 2 diabetes later in life.

People with Type 1 diabetes are unable to produce insulin, after the insulin-producing cells in the pancreas are destroyed by the body's own immune system. It is not known what causes the body to attack itself like this, but it is thought that some kind of viral infection or other environmental factor may be responsible in susceptible individuals.

Around one in every 700 Australian children has diabetes, which makes it the most common serious disease amongst children. Juvenile diabetes (Type 1) can affect anyone of any age, but is more common in people under 30 years and tends to develop in childhood, hence its name.

Shelia Royles, CEO of the Juvenile Diabetes Research Foundation says that although children with juvenile diabetes look healthy, their life is anything but normal. They have to adjust everything they do to manage the disease - even simple things like attending a birthday party or playing sport takes careful planning.

People with Type 2 diabetes produce insulin but their bodies are unable to use it effectively. Type 2 is usually diagnosed in adulthood and is often accompanied by obesity, hypertension and high cholesterol levels.

As a result, it can be treated with lifestyle changes and oral medication. It does not generally require insulin injections. However, there is now an alarming increased incidence of Type 2 diabetes being diagnosed in children.

Thanks to modern food and a less physically active society, thousands of obese Australian children and teenagers, some as young as 10, have diabetes. Ten years ago, children with Type 2 diabetes, brought on by obesity, were virtually unheard of.

Now diabetes is set to reach epidemic levels. Endocrinologists predict a twenty-fold rise in the disease over the next decade among teenagers. Unless the disease is diagnosed and treated, diabetic children may suffer from heart attacks, blindness and kidney disease in their late 20s.

Diagnosis and Treatment

Diabetes is diagnosed with blood tests to check glucose levels. There is no cure for Type 1 diabetes, but the condition can be successfully managed. To maintain normal blood glucose levels, a person with Type 1 diabetes needs to carefully balance food intake, physical activity and insulin dose.

• Self-monitoring of blood sugar levels by regularly testing droplets of blood in a glucose meter, 4-6 times a day 
• Self-testing of urine to check for high levels of ketones, using a test strip
• Taking insulin injections daily (2-5 a day)
• Increasing the amount of 'slow' carbohydrates in the diet, such as beans and fruit, which take longer to be absorbed by the body
• Regular exercise
• Maintaining regular checks for diabetes complications

Insulin is not a cure for Type 1 diabetes, nor does it prevent the eventual and devastating complications of diabetes.

Type 2 diabetes is the fastest growing disease in the western world, yet one of the most preventable. A healthy and nutritious eating plan, together with an active lifestyle, plays an important role in maintaining health and well-being.

This is particularly important for people with diabetes (or at risk of developing diabetes), high cholesterol, high blood pressure or obesity. By making lifestyle changes now, those at risk may be able to help prevent diabetes from developing.

Complications of Diabetes

• Kidney damage – about 40% of people with Type 1 diabetes develop severe kidney disease by the age of 50 and it is one of the most common causes of end stage renal disease.
• Increased likelihood of infections such as thrush.
• Damage to the eyes – diabetic retinopathy is the leading cause of blindness in Australians under 60 years.
• Poor blood circulation in the legs and feet, potentially leading to lower limb amputation (leading cause of amputation not caused by an accident).
• Damage to the nerves of the feet.
• Significantly increased likelihood of heart disease and stroke.
• Sexual impotence.

If a person with insulin dependent diabetes skips a meal, exercises heavily or takes too much insulin, their blood sugar levels may plummet. This leads to a 'hypo' (hypoglycaemia). The symptoms include dizziness, sweating, hunger, headache and change in mood.

This can be remedied with a quick boost of sugar (such as jellybeans or glucose tablets), then something more substantial like fruit. Ideally, lollies should be on hand at all times, just in case.  If untreated, it will lead to coma and death.

Diet Makes a Difference

Carbohydrates are the body's preferred fuel source and were until recently classified as either 'simple' (sugars) or 'complex' (starches), depending on their chemical configuration and the presence of fibre. These terms are rapidly becoming obsolete as foods are now rated on a scale called the glycaemic index, or ‘GI’.

The GI measures the rise in blood sugar levels caused by a measured quantity of a particular food. Foods are given a score out of 100, where white bread (GI of 70) is used as a reference food and all foods are compared to it.

Those that take longer to be absorbed are called 'low GI' (GI less than 55). Carbohydrates which are faster to absorb are called 'high GI' (GI greater than 70). It is recommended that all people, and especially people with diabetes, choose to eat low GI foods most of the time.

Some foods on the Australian market already show their GI rating on the nutrition information panel. Foods with a high GI are those which are rapidly digested and absorbed and result in marked fluctuations in blood sugar levels.

Low-GI foods, by virtue of their slow digestion and absorption, produce gradual rises in blood sugar and insulin levels, and have proven benefits for health.

The value of eating low GI food for people with Type 1 diabetes is that it reduces the amount of insulin needed, thus making it easier to manage blood glucose levels. For people with Type 2 diabetes, low GI foods can assist in weight loss and maintenance, a key factor in treatment.

Some examples of the GI rating of various carbohydrates include:

• Low GI (less than 55) - soy products, beans, fruit, milk, grainy bread
• Medium GI (55 to 70) - sugar, orange juice and oats
• High GI (greater than 70) - potatoes, wholemeal and white bread, and rice.

Researching a Cure

In Australia, the Juvenile Diabetes Research Foundation (JDRF) funded more than $10 million of world class research last financial year. Exciting and rapid research advances in recent years have opened the door to a new understanding of diabetes.

Recently, Australia’s first islet transplant was performed at Westmead Hospital in Sydney. The transplantation of insulin producing cells, known as islets, offers hope of a cure for people with Type 1 diabetes. When islets are transplanted from a donated pancreas, they begin to secrete insulin and re-establish normal control of the body's blood sugar metabolism.

Another breakthrough for Type 1 sufferers has been the development of internal and external insulin pumps. The internal pump is inserted in the body and is the closest thing to an artificial pancreas, releasing a continuous measured amount of insulin into the body. These pumps do away with the need to self administer insulin via injection.

It is important to note that islet transplantation and internal insulin pumps are still experimental procedures and are not available to everyone.  Stem cell research provides the best opportunity we have for finding a cure for Type 1 diabetes. 

Statistics

• there are around 900,000 people with diabetes in Australia – around 90% of them are Type 2
• at least 80% of Type 2 diabetics are overweight or obese
• there are around 100,000 people with Type 1 diabetes - 98% of them are children
• the incidence of Type 1 diabetes in children in Australia is high compared with other countries
• Type 1 diabetes can strike infants as young as 10 weeks old
• an individual with Type 1 diabetes will take over 60,000 injections and over 80,000 finger prick blood tests in a lifetime

Common Symptoms of Undiagnosed Diabetes

• Excessive desire to drink
• Frequent passage of urine
• Increased fatigue or lethargy
• Severe irritation and itching
• Excessive hunger
• Blurred vision
• Weight Loss

Type 1 (Juvenile) Diabetes

• abrupt onset
• normally age under 20 years
• symptoms at diagnosis
• auto-immune mediated
• no Beta cell function
• no insulin production
• insulin therapy required
• normally no family history
• not usually overweight
• cannot be managed by diet or lifestyle choices
• cannot be prevented

Type 2 Diabetes

• gradual onset
• normally age over 35 years
• frequently no symptoms
• erratic Beta cell function
• insulin normal or raised
• oral drugs may be used
• family history common
• usually overweight
• can be managed through diet and lifestyle changes

Where to get help:

• Your doctor
• Diabetes Australia Website 
• International Diabetes Institute (IDI) Website 
• Australian Diabetes Society Website
• Australian Diabetes Educators Association Website 
• Australasian Diabetes in Pregnancy Society Website 
• Diabetes Australia Victoria  
• Juvenile Diabetes Research Foundation  Tel 1300 363 126
  JDFA is the Juvenile Diabetes Foundation Australia. The foundation was established in 1982, by a group of Australian parents to deliver hope and compassion to children facing a lifetime of insulin injections and probable health complications. As a direct result of JDF's efforts to fund and promote Diabetes research, the mysteries of juvenile Diabetes are being unravelled. 
• Children with diabetes website

by Monique Webber

Source: Diabetes Centre, Endocrinology, North Western Adelaide Health Service, The Queen Elizabeth Hospital, South Australia Website.

Thanks to the Juvenile Diabetes Research Foundation for their assistance with this article.

The information provided in this article is intended as a guide only. Always consult your doctor if you or your child is suffering any medical complaint. Any websites referred to by Australian Family contain information moderated by government and medical institutions or organisations.

This article was first published in Australian Family Magazine, March 2003. Updated July 2009.